{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022\/\/cdn.jsdelivr.net\/qtip2\/2.2.1\/jquery.qtip.min.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/www.jrheum.org\/sites\/default\/files\/js\/js_YjAJQgxDlFX6S-O02jj9jCrVbrwlY3CGgCg1FzPlvBs.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\nif(typeof window.MathJax === \u0022undefined\u0022) window.MathJax = { menuSettings: { zoom: \u0022Click\u0022 } };\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/www.jrheum.org\/sites\/default\/files\/js\/js_gPqjYq7fqdMzw8-29XWQIVoDSWTmZCGy9OqaHppNxuQ.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-82328695-1\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022anonymizeIp\u0022, true);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-76034214-12\u0027, \u0027auto\u0027,\r\n{\u0027name\u0027: \u0027hwTracker\u0027}\r\n);\r\nga(\u0027set\u0027, \u0027anonymizeIp\u0027, true);\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022ac\u0022:{\u0022\\\/jrheum\\\/36\\\/3\\\/623.atom\u0022:{\u0022access\u0022:{\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022\u0022,\u0022apath\u0022:\u0022\\\/jrheum\\\/36\\\/3\\\/623.atom\u0022,\u0022jcode\u0022:\u0022jrheum\u0022}},\u0022processed\u0022:[\u0022highwire_math\u0022],\u0022markup\u0022:[{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022jrheum;36\\\/3\\\/623\u0022}],\u0022trendmd\u0022:{\u0022trendmd-suggestions\u0022:\u0022{\\u0022element\\u0022:\\u0022#trendmd-suggestions\\u0022,\\u0022track_id\\u0022:\\u0022null\\u0022}\u0022}},\u0022instances\u0022:\u0022{\\u0022highwire_abstract_tooltip\\u0022:{\\u0022content\\u0022:{\\u0022text\\u0022:\\u0022\\u0022},\\u0022style\\u0022:{\\u0022tip\\u0022:{\\u0022width\\u0022:20,\\u0022height\\u0022:20,\\u0022border\\u0022:1,\\u0022offset\\u0022:0,\\u0022corner\\u0022:true},\\u0022classes\\u0022:\\u0022qtip-custom hw-tooltip hw-abstract-tooltip qtip-shadow qtip-rounded\\u0022,\\u0022classes_custom\\u0022:\\u0022hw-tooltip hw-abstract-tooltip\\u0022},\\u0022position\\u0022:{\\u0022at\\u0022:\\u0022right center\\u0022,\\u0022my\\u0022:\\u0022left center\\u0022,\\u0022viewport\\u0022:true,\\u0022adjust\\u0022:{\\u0022method\\u0022:\\u0022shift\\u0022}},\\u0022show\\u0022:{\\u0022event\\u0022:\\u0022mouseenter click \\u0022,\\u0022solo\\u0022:true},\\u0022hide\\u0022:{\\u0022event\\u0022:\\u0022mouseleave \\u0022,\\u0022fixed\\u0022:1,\\u0022delay\\u0022:\\u0022100\\u0022}},\\u0022highwire_author_tooltip\\u0022:{\\u0022content\\u0022:{\\u0022text\\u0022:\\u0022\\u0022},\\u0022style\\u0022:{\\u0022tip\\u0022:{\\u0022width\\u0022:15,\\u0022height\\u0022:15,\\u0022border\\u0022:1,\\u0022offset\\u0022:0,\\u0022corner\\u0022:true},\\u0022classes\\u0022:\\u0022qtip-custom hw-tooltip hw-author-tooltip qtip-shadow qtip-rounded\\u0022,\\u0022classes_custom\\u0022:\\u0022hw-tooltip hw-author-tooltip\\u0022},\\u0022position\\u0022:{\\u0022at\\u0022:\\u0022top center\\u0022,\\u0022my\\u0022:\\u0022bottom center\\u0022,\\u0022viewport\\u0022:true,\\u0022adjust\\u0022:{\\u0022method\\u0022:\\u0022\\u0022}},\\u0022show\\u0022:{\\u0022event\\u0022:\\u0022mouseenter \\u0022,\\u0022solo\\u0022:true},\\u0022hide\\u0022:{\\u0022event\\u0022:\\u0022mouseleave \\u0022,\\u0022fixed\\u0022:1,\\u0022delay\\u0022:\\u0022100\\u0022}},\\u0022highwire_reflinks_tooltip\\u0022:{\\u0022content\\u0022:{\\u0022text\\u0022:\\u0022\\u0022},\\u0022style\\u0022:{\\u0022tip\\u0022:{\\u0022width\\u0022:15,\\u0022height\\u0022:15,\\u0022border\\u0022:1,\\u0022mimic\\u0022:\\u0022top center\\u0022,\\u0022offset\\u0022:0,\\u0022corner\\u0022:true},\\u0022classes\\u0022:\\u0022qtip-custom hw-tooltip hw-ref-link-tooltip qtip-shadow qtip-rounded\\u0022,\\u0022classes_custom\\u0022:\\u0022hw-tooltip hw-ref-link-tooltip\\u0022},\\u0022position\\u0022:{\\u0022at\\u0022:\\u0022bottom left\\u0022,\\u0022my\\u0022:\\u0022top left\\u0022,\\u0022viewport\\u0022:true,\\u0022adjust\\u0022:{\\u0022method\\u0022:\\u0022flip\\u0022}},\\u0022show\\u0022:{\\u0022event\\u0022:\\u0022mouseenter \\u0022,\\u0022solo\\u0022:true},\\u0022hide\\u0022:{\\u0022event\\u0022:\\u0022mouseleave \\u0022,\\u0022fixed\\u0022:1,\\u0022delay\\u0022:\\u0022100\\u0022}}}\u0022,\u0022qtipDebug\u0022:\u0022{\\u0022leaveElement\\u0022:0}\u0022,\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackColorbox\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022\\\/\\\/cdn.jsdelivr.net\\\/qtip2\\\/2.2.1\\\/jquery.qtip.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u00220\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00221\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/www.jrheum.org\/sites\/default\/files\/advagg_css\/css__uXgUByez87OKDsgffPHe7u5qNUzr7zOnqWrSJ87THKk__RR-QNYl6SsTObm37M1MaRCUwwzIP19wUZLcqO_pRc1Q__7POnK7Df4uIlBihHI8TkE3mvqVh4xmC4ZTJZZ9uyIyo.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/cdn.jsdelivr.net\/qtip2\/2.2.1\/jquery.qtip.min.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/www.jrheum.org\/sites\/default\/files\/advagg_css\/css__HGACIFBlu2o05y3afvqlt5wrE_5Dn6MXsexfuEpeIwg__bZRPPTxGBklJTL0kiU8ickehU_1TeXhqoRdbfYVaapM__7POnK7Df4uIlBihHI8TkE3mvqVh4xmC4ZTJZZ9uyIyo.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-jnl-jrheum-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n \n \n \n \u003Cdiv class=\u0022pane-content\u0022\u003E\n \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 data-highwire-cite-ref-tooltip-instance=\u0022highwire_reflinks_tooltip\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view\u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003EAbstract\u003C\/h2\u003E\n\n\n\u003Cp id=\u0022p-1\u0022\u003E\u003Cstrong\u003EObjective.\u003C\/strong\u003E To evaluate the effectiveness of an online module in the development of medical students\u2019 clinical hand examination skills.\u003C\/p\u003E\n\n\n\u003Cp id=\u0022p-2\u0022\u003E\u003Cstrong\u003EMethods.\u003C\/strong\u003E We developed a Web-based module to teach examination of the hand to first-year medical students (n = 99) to address the core skills expected in undergraduate medical training in Canada. The module was compared to the standard recommended text and tutor-led teaching using a validated objective structured clinical examination (OSCE) and a written knowledge test.\u003C\/p\u003E\n\n\n\u003Cp id=\u0022p-3\u0022\u003E\u003Cstrong\u003EResults.\u003C\/strong\u003E A total of 17 students completed the OSCE from the book-based learning group, 18 from the tutor-led group, and 26 from the online module group. The average total OSCE score was significantly higher for students in the online module group compared to the textbook group (73.2% and 60.5%, respectively; p = 0.003). There was no significant difference between students in the online module and tutor-led groups (73.2% and 69.0%, respectively; p = 0.31). The online module group had a significantly higher mean total knowledge score than the textbook group (8.4 and 5.7, respectively; p \u0026lt; 0.001; maximum score 10) and the tutor-led group (8.4 and 7.4, respectively; p = 0.04).\u003C\/p\u003E\n\n\n\u003Cp id=\u0022p-4\u0022\u003E\u003Cstrong\u003EConclusion.\u003C\/strong\u003E Our study provides evidence that a well designed Web-based module, supported by sound educational theory, is an effective tool in the teaching of musculoskeletal examination skills, and provides some advantages over tutor-led teaching in terms of knowledge retention.\u003C\/p\u003E\u003C\/div\u003E\u003Cspan class=\u0022kwd-group-title\u0022\u003EKeywords: \u003C\/span\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003E\u003Ca href=\u0022\/keyword\/rheumatology\u0022 class=\u0022hw-term hw-article-keyword hw-article-keyword-rheumatology\u0022 rel=\u0022nofollow\u0022\u003ERHEUMATOLOGY\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003E\u003Ca href=\u0022\/search\/%20text_abstract_title%3AMEDICAL%2BEDUCATION%20text_abstract_title_flags%3Amatch-phrase%20sort%3Apublication-date\u0022 class=\u0022hw-term hw-article-keyword hw-article-keyword-medical-education\u0022 rel=\u0022nofollow\u0022\u003EMEDICAL EDUCATION\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003E\u003Ca href=\u0022\/search\/%20text_abstract_title%3ACOMPUTERS%20text_abstract_title_flags%3Amatch-phrase%20sort%3Apublication-date\u0022 class=\u0022hw-term hw-article-keyword hw-article-keyword-computers\u0022 rel=\u0022nofollow\u0022\u003ECOMPUTERS\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003E\u003Ca href=\u0022\/keyword\/physical-examination\u0022 class=\u0022hw-term hw-article-keyword hw-article-keyword-physical-examination\u0022 rel=\u0022nofollow\u0022\u003EPHYSICAL EXAMINATION\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-5\u0022\u003EThe teaching of musculoskeletal examination is challenging for a number of reasons. Students find it overwhelming and difficult to develop an approach that is consistent, clinically relevant, and succinct, resulting in deficiencies in musculoskeletal examination skills at both under- and postgraduate level\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-1\u0022 id=\u0022xref-ref-1-1\u0022\u003E1\u003C\/a\u003E,\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-2\u0022 id=\u0022xref-ref-2-1\u0022\u003E2\u003C\/a\u003E\u003C\/sup\u003E. This difficulty may be compounded by the lack of a standardized approach presented by different specialists and the level of detail in textbooks and manuals. Additional challenges include financial constraints at institutions, reduced tutor availability, and increasing pressure on the medical curriculum\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-3\u0022 id=\u0022xref-ref-3-1\u0022\u003E3\u003C\/a\u003E\u003C\/sup\u003E. Focused feedback from groups of medical students at this institution has confirmed these perceived deficiencies. For example, students consistently noted an incongruity among the content of the textbook, the undergraduate course curriculum, and the Medical Council of Canada (MCC) Objectives\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-4\u0022 id=\u0022xref-ref-4-1\u0022\u003E4\u003C\/a\u003E\u003C\/sup\u003E. We have chosen a Web-based solution as a means of circumventing these problems with traditional educational media.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EComputer assisted learning (CAL) is increasingly being used in medical education, but research justifying its use remains limited\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-5\u0022 id=\u0022xref-ref-5-1\u0022\u003E5\u003C\/a\u003E\u003C\/sup\u003E. Many CAL packages have focused on knowledge acquisition\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-6\u0022 id=\u0022xref-ref-6-1\u0022\u003E6\u003C\/a\u003E,\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-7\u0022 id=\u0022xref-ref-7-1\u0022\u003E7\u003C\/a\u003E\u003C\/sup\u003E. CAL has also been seen to be effective in teaching some psychomotor skills; Xeroulis, \u003Cem\u003Eet al\u003C\/em\u003E showed that computer based video instruction is an effective instructional tool in teaching suture and knot-tying skills to medical students\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-8\u0022 id=\u0022xref-ref-8-1\u0022\u003E8\u003C\/a\u003E\u003C\/sup\u003E. CAL can be used for teaching examination skills such as cardiac auscultation\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-9\u0022 id=\u0022xref-ref-9-1\u0022\u003E9\u003C\/a\u003E\u003C\/sup\u003E, skin examination\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-10\u0022 id=\u0022xref-ref-10-1\u0022\u003E10\u003C\/a\u003E\u003C\/sup\u003E, and mobility assessment\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-11\u0022 id=\u0022xref-ref-11-1\u0022\u003E11\u003C\/a\u003E\u003C\/sup\u003E. In terms of musculoskeletal clinical skills, Vivekananda-Schmidt, \u003Cem\u003Eet al\u003C\/em\u003E\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-3\u0022 id=\u0022xref-ref-3-2\u0022\u003E3\u003C\/a\u003E\u003C\/sup\u003E showed that an educational CD teaching rheumatology examination skills had a positive measurable educational effect on acquisition of examination skills. However, the role of Web-based modules for teaching musculoskeletal clinical examination needs formal research before innovative teaching methods supported by educational theory are more widely accepted.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EOur aim was to evaluate the role of an online module on clinical examination of the hands in teaching students to develop examination skills as compared to tutor-led clinical skills teaching and the use of a textbook on physical examination.\u003C\/p\u003E\u003Cdiv class=\u0022section materials-methods\u0022 id=\u0022sec-5\u0022\u003E\n\u003Ch2\u003EMATERIALS AND METHODS\u003C\/h2\u003E\n\u003Cp id=\u0022p-8\u0022\u003EWe developed a Web-based module to teach examination of the hand in non-emergency rheumatological conditions to help students develop their approach. The Web-based module and tutor-led teaching sessions aimed to address the core skills that are expected of undergraduate medical training in Canada defined in the MCC Objectives\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-4\u0022 id=\u0022xref-ref-4-2\u0022\u003E4\u003C\/a\u003E\u003C\/sup\u003E and also the Regional Examination of the Musculoskeletal System (REMS) core set developed by Coady, \u003Cem\u003Eet al\u003C\/em\u003E\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-12\u0022 id=\u0022xref-ref-12-1\u0022\u003E12\u003C\/a\u003E\u003C\/sup\u003E. A key factor in the design of the Web-based learning tool was consistency between the module, the curriculum, and the MCC objectives.\u003C\/p\u003E\n\u003Cp id=\u0022p-9\u0022\u003EThe module taught the sequence of the examination, with photographs demonstrating a range of possible conditions that could be seen on inspection, photographs showing clearly how to palpate and move the joints, discussion of pattern recognition in osteoarthritis and rheumatoid arthritis, and assessment of nerve injury. In the module, objectives were clearly defined and put in context by describing typical clinical scenarios. The learning sequence was made clear by the intuitive nature of the Web-based design. The student had the opportunity for reinforcing and repeating the learning, and needed only to move to the next step when ready. A checklist at the end of the module reinforced the key learning points and sequence.\u003C\/p\u003E\n\u003Cp id=\u0022p-10\u0022\u003EThe effectiveness of the module was assessed using a validated OSCE\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-13\u0022 id=\u0022xref-ref-13-1\u0022\u003E13\u003C\/a\u003E\u003C\/sup\u003E with the permission of the authors, and a brief written knowledge test (see \u003Ca class=\u0022xref-app\u0022 href=\u0022#app-1\u0022 id=\u0022xref-app-1-1\u0022\u003EAppendix\u003C\/a\u003E).We ensured that all parts of the OSCE examination and knowledge test were clearly covered in the module, lecture, and the textbook. We were careful to ensure that the content of the module and tutor-led sessions was consistent, and to facilitate this we preceded the practical part of the tutor-led teaching by a brief PowerPoint introduction.\u003C\/p\u003E\n\u003Cp id=\u0022p-11\u0022\u003EThe learners were all first-year medical students at Queen\u2019s University, Kingston, who had never been exposed to formal training in hand examination, but who had attended a lecture in the first term on the GALS (gait, arms, legs, and spine) musculoskeletal screen\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-14\u0022 id=\u0022xref-ref-14-1\u0022\u003E14\u003C\/a\u003E\u003C\/sup\u003E and were thus familiar with the concept of inspection, palpation, and movement of joints. Since we were targeting a specific group this was a sample of convenience. We did not formally ascertain if previous teaching of hand examination had occurred in training outside the medical program.\u003C\/p\u003E\n\u003Cp id=\u0022p-12\u0022\u003EThe objectives of the hand teaching were: (1) to develop a standard approach to examination of the hands and wrists in any patient presenting with rheumatic disease; (2) to recognize a range of clinical signs and understand the relevance of these in the examination of the hands and wrists; (3) to recognize and describe the classical patterns of joint involvement in rheumatoid arthritis and osteoarthritis; and (4) to be aware that other (i.e., nonrheumatological) diseases can result in clinical signs in the hands and to be able to describe some of these.\u003C\/p\u003E\n\u003Cp id=\u0022p-13\u0022\u003EThe students were randomized using a computer-based random number generator into 3 groups: Group 1 \u2013 Students attended a practical session led by a rheumatologist taking them through the examination of the hand in a patient with polyarthritis. The demonstration included discussion of possible findings at each stage with an initial PowerPoint presentation showing photographs identical to those described in the online module. During the practical component the sequence of the examination was emphasized, and reinforced by the students practicing on each other with the tutor watching and ensuring correct clinical method. The tutor was able to ask questions to the students to ensure understanding and reinforce learning points and to offer immediate and relevant feedback. Group 2 \u2013 Students were invited to learn about the examination of the hand using the online module. They did not have practical teaching. Access to the Web-based module was limited to that group by user-name and password to avoid contamination of the other 2 groups. Group 3 \u2013 Students were asked to read the recommended text on hand examination\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-15\u0022 id=\u0022xref-ref-15-1\u0022\u003E15\u003C\/a\u003E\u003C\/sup\u003E. The book contained all the information necessary but not in the sequence of learning as presented in the module. The students were asked to learn how to undertake clinical examination of the hand in a patient with joint pain.\u003C\/p\u003E\n\u003Cp id=\u0022p-14\u0022\u003EWe did not limit the time for Groups 2 and 3 to read about the skills or use the Website, as we felt this should mirror the current practice of students and the aims of the module. Practice of the clinical examination techniques was encouraged within the groups. No additional relevant teaching or lectures were scheduled on their timetable before the assessment.\u003C\/p\u003E\n\u003Cp id=\u0022p-15\u0022\u003ESeven days after the material was available we assessed the students with the hand OSCE. The examiners were blinded to the intervention. A brief written evaluation of the teaching method and a knowledge-based test took place immediately after the OSCE.A mean difference in OSCE scores of 10% was assumed to be of educational significance\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-16\u0022 id=\u0022xref-ref-16-1\u0022\u003E16\u003C\/a\u003E\u003C\/sup\u003E. As part of the ethics submission we agreed to offer remedial training to students if it was clear that they had been at a disadvantage in terms of their group allocation.\u003C\/p\u003E\n\u003Cp id=\u0022p-16\u0022\u003EThe following 2 primary hypotheses were prespecified: (1) Null hypothesis: The average total OSCE score is the same between students randomized to the standard text method compared to the online module teaching method. Alternative hypothesis: the average is not the same in the 2 groups (2-sided). (2) Null hypothesis: The average total OSCE score is at least 10% higher with the tutor-led teaching technique than with the online module. Alternative hypothesis: The average total OSCE score is no more than 10% higher with the tutor-led teaching compared to the online module (1-sided).\u003C\/p\u003E\n\u003Cp id=\u0022p-17\u0022\u003EHypotheses 1 and 2 were tested separately by the independent t-test. Normality of the total OSCE scores was confirmed within group by box plots and the Kolmogorov-Smirnov test. The total OSCE score, which has a possible range from 0 to 28 points, was converted to a percentage by multiplying the raw score by 100\/28.\u003C\/p\u003E\n\u003Cp id=\u0022p-18\u0022\u003EThe 5-point visual analog scale ratings of usefulness, ease, and understanding were compared between groups by a 2-sided exact Cochrane-Armitage trend test.\u003C\/p\u003E\n\u003Cp id=\u0022p-19\u0022\u003EThe average total knowledge score was compared between groups by a 2-sided independent t-test. Time spent, which was positively skewed, was compared between the book and the online module groups by a 2-sided Wilcoxon-Mann-Whitney test. All analysis was performed with SAS Version 9.1 (SAS Institute Inc., Cary, NC, USA).\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section results\u0022 id=\u0022sec-6\u0022\u003E\n\u003Ch2\u003ERESULTS\u003C\/h2\u003E\n\u003Cp id=\u0022p-20\u0022\u003EA total of 99 students were invited to participate in the study and were randomized into 3 groups of 33. The study was entirely voluntary and many students were anxious about attending an OSCE. The statistical analysis is based on a total of 17 students who completed the OSCE from the book-based learning group, 18 from the formal teaching group, and 26 from the online module group. The age and sex distribution in the 3 groups is shown in \u003Ca class=\u0022xref-table\u0022 href=\u0022#T1\u0022 id=\u0022xref-table-wrap-1-1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv class=\u0022table\u0022 id=\u0022T1\u0022\u003E\u003Cdiv class=\u0022table-inline table-callout-links\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u0022view-inline first\u0022\u003E\u003Ca href=\u0022##\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16077\/expansion?postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u0022view-popup last\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16077\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n\u003Cp id=\u0022p-46\u0022 class=\u0022first-child\u0022\u003EDemographics of the 3 teaching groups.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\n\u003Ch3\u003EPrimary outcome (total OSCE score).\u003C\/h3\u003E\n\u003Cp id=\u0022p-21\u0022\u003EThe distribution of the total OSCE score appears roughly Gaussian in each group (\u003Ca class=\u0022xref-fig\u0022 href=\u0022#F1\u0022 id=\u0022xref-fig-1-1\u0022\u003EFigure 1\u003C\/a\u003E), and in each group the Kolmogorov-Smirnov test did not reject the null hypothesis that the data came from a normal distribution (all 3 groups p \u0026gt; 0.15). \u003Ca class=\u0022xref-table\u0022 href=\u0022#T2\u0022 id=\u0022xref-table-wrap-2-1\u0022\u003ETable 2\u003C\/a\u003E presents the means of the total OSCE scores with 95% confidence intervals for each group. The average total OSCE score was 12.7% (95% CI 4.7% to 20.7%; p = 0.003) higher for students randomized to the online module compared to those randomized to the book method, and 4.2% (95% CI \u20134.0% to 12.3%; p = 0.31) higher than those randomized to the tutor-led teaching technique. This nonsignificant advantage of the online module compared to the tutor-led teaching technique rules out the possibility that the online module is at least 10% worse than the tutor-led teaching technique at p = 0.0006.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/www.jrheum.org\/content\/jrheum\/36\/3\/623\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Box represents the middle 50% (interquartile range) of the data, outer bands represent the range of the data. Horizontal line and diamond represent the median and mean, respectively. These data appear roughly symmetrical and are consistent with the Gaussian distribution.\u0022 class=\u0022highwire-fragment fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-768309027\u0022 data-figure-caption=\u0022\u0026lt;div class=\u0026quot;highwire-markup\u0026quot;\u0026gt;Box represents the middle 50% (interquartile range) of the data, outer bands represent the range of the data. Horizontal line and diamond represent the median and mean, respectively. These data appear roughly symmetrical and are consistent with the Gaussian distribution.\u0026lt;\/div\u0026gt;\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cspan class=\u0022hw-responsive-img\u0022\u003E\u003Cimg class=\u0022highwire-fragment fragment-image lazyload\u0022 alt=\u0022Figure 1.\u0022 src=\u0022data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\u0022 data-src=\u0022http:\/\/www.jrheum.org\/content\/jrheum\/36\/3\/623\/F1.medium.gif\u0022 width=\u0022440\u0022 height=\u0022315\u0022\/\u003E\u003Cnoscript\u003E\u003Cimg class=\u0022highwire-fragment fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/www.jrheum.org\/content\/jrheum\/36\/3\/623\/F1.medium.gif\u0022 width=\u0022440\u0022 height=\u0022315\u0022\/\u003E\u003C\/noscript\u003E\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u0022download-fig first\u0022\u003E\u003Ca href=\u0022http:\/\/www.jrheum.org\/content\/jrheum\/36\/3\/623\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u0022new-tab\u0022\u003E\u003Ca href=\u0022http:\/\/www.jrheum.org\/content\/jrheum\/36\/3\/623\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u0022download-ppt last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16075\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n\u003Cp id=\u0022p-45\u0022 class=\u0022first-child\u0022\u003EBox represents the middle 50% (interquartile range) of the data, outer bands represent the range of the data. Horizontal line and diamond represent the median and mean, respectively. These data appear roughly symmetrical and are consistent with the Gaussian distribution.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table\u0022 id=\u0022T2\u0022\u003E\u003Cdiv class=\u0022table-inline table-callout-links\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u0022view-inline first\u0022\u003E\u003Ca href=\u0022##\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16079\/expansion?postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u0022view-popup last\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16079\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n\u003Cp id=\u0022p-47\u0022 class=\u0022first-child\u0022\u003EMeans of total objective structured clinical examination scores; percentage by learning method.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\n\u003Ch3\u003ESecondary outcomes.\u003C\/h3\u003E\n\u003Cp id=\u0022p-22\u0022\u003EThe total knowledge score was also highest in the online training group and lowest in the book group (\u003Ca class=\u0022xref-table\u0022 href=\u0022#T3\u0022 id=\u0022xref-table-wrap-3-1\u0022\u003ETable 3\u003C\/a\u003E). The online module group had a significantly higher total knowledge score than the book group [mean difference 2.7 (95% CI 1.5 to 3.9); p \u0026lt; 0.001] and a slightly higher score than the formal training group [mean difference 1.0 (95% CI 0.05 to 1.9); p = 0.04].\u003C\/p\u003E\u003Cdiv class=\u0022table\u0022 id=\u0022T3\u0022\u003E\u003Cdiv class=\u0022table-inline table-callout-links\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u0022view-inline first\u0022\u003E\u003Ca href=\u0022##\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16080\/expansion?postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u0022view-popup last\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16080\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_tables%2Chighwire_reclass%2Chighwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n\u003Cp id=\u0022p-48\u0022 class=\u0022first-child\u0022\u003ETotal knowledge score by group (maximum score of 10).\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n\u003Cp id=\u0022p-23\u0022\u003ECompared to reading a text, the students agreed more strongly that only the module was useful (p = 0.004), was easy to use (p = 0.013), and helped understand the sequence (p = 0.046). The students found the online module of similar usefulness to formal instruction (p = 1.0), and not significantly different for understanding the sequence (p = 0.22).\u003C\/p\u003E\n\u003Cp id=\u0022p-24\u0022\u003EThe median time spent was 60 min for the online module compared to only 30 min for the book (p = 0.033). Students felt the online module was more useful and easy to use, and allowed them to understand the sequence better than the text method, and they found it of similar usefulness to the tutor-led teaching technique.\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section discussion\u0022 id=\u0022sec-9\u0022\u003E\n\u003Ch2\u003EDISCUSSION\u003C\/h2\u003E\n\u003Cp id=\u0022p-25\u0022\u003EOur study suggests that in terms of the total OSCE score, the online module is superior to reading the recommended text and comparable to practical clinical skills teaching led by a clinician, and for the knowledge test the module was superior to both other teaching methods. These results are reassuring for clinical skills course organizers.\u003C\/p\u003E\n\u003Cp id=\u0022p-26\u0022\u003EIntuitively, one would expect a Web-based module to have advantages over a textbook. With Web-based modules the teacher still selects and organizes the instructional method, defining objectives as learning outcomes. Such instructional objectives are less clear in a book chapter, which may not define the terminal skill as clearly. Another disadvantage of many textbooks, including the one chosen by this medical school, is lack of clarity regarding the sequence of the hand examination, and a paucity of photographs clearly showing the methods of palpation. The organization of the book\u2019s content was less intuitive, and the students were required to filter out what might be important. Both CAL programs and textbooks can be used at times that suit the learner. A Web-based module or video cannot aim to replace a tutor\u2019s ability to demonstrate and reinforce correct technique, but if it is well designed, we have shown that students can learn the psychomotor skills and still perform at a high level. We do not anticipate that such resources would fully replace formal tutor-led clinical skill teaching, but the results of our study do show that this is a possible goal. Further studies would be important to investigate how students would respond to substitution of faculty-based skills teaching by CAL. More realistically, we would suggest that use of such Web-based resources prior to formal clinical skills classes might improve the efficiency of teaching by ensuring students arrived already prepared. In this way, CAL has the potential to decrease the amount of time needed by both students and faculty to master the acquisition of clinical skills\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-17\u0022 id=\u0022xref-ref-17-1\u0022\u003E17\u003C\/a\u003E\u003C\/sup\u003E.\u003C\/p\u003E\n\u003Cp id=\u0022p-27\u0022\u003EWeb-based resources thus offer a method of teaching clinical examination skills, and potential savings in terms of resources are very significant, particularly in terms of physical space and tutor time. With the Virtual Rheumatology CD the cost of this intervention ($22,045) predominantly arose from the cost of producing the CDs\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-3\u0022 id=\u0022xref-ref-3-3\u0022\u003E3\u003C\/a\u003E\u003C\/sup\u003E. Web-based resources are considerably less expensive; for example this module was prepared on Exe, a freely available authoring tool. CAL is also used for teaching other aspects of rheumatology; Wilson, \u003Cem\u003Eet al\u003C\/em\u003E developed an interactive Web-based tool teaching rheumatology through clinical case studies\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-18\u0022 id=\u0022xref-ref-18-1\u0022\u003E18\u003C\/a\u003E\u003C\/sup\u003E. This tool was both effective and well received by medical students and thus had a clear role in effective use of medical school resources.\u003C\/p\u003E\n\u003Cp id=\u0022p-28\u0022\u003ENovice learners benefit most when information is organized, provided in a logical and clinically relevant sequence, and readily available. When information is organized into specific and manageable portions, the cognitive load in working memory is reduced, allowing the material to be recalled more easily\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-19\u0022 id=\u0022xref-ref-19-1\u0022\u003E19\u003C\/a\u003E\u003C\/sup\u003E. Providing a logical sequence that models clinical decision-making promotes schema development, longterm recall, and the ability to transfer these skills into clinical situations. For example, Owen and Plummer\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-20\u0022 id=\u0022xref-ref-20-1\u0022\u003E20\u003C\/a\u003E\u003C\/sup\u003E broke down the procedure of endotracheal intubation into meaningful and discrete elements for students and trainees. They were careful not to overwhelm them with details in the early stages, allowing instead for the students to progress through a sequence of subtasks towards mastery. After a single session, the majority (93%) reached the required standard to attempt intubation on a patient.\u003C\/p\u003E\n\u003Cp id=\u0022p-29\u0022\u003EWhen learners can access material when it is convenient or most relevant, they are able to advance their learning at a point where they are most receptive to the information. This \u201cjust-in-time\u201d learning\u003Csup\u003E\u003Ca class=\u0022xref-bibr\u0022 href=\u0022#ref-21\u0022 id=\u0022xref-ref-21-1\u0022\u003E21\u003C\/a\u003E\u003C\/sup\u003E can be facilitated by Web-based instruction that gives students flexibility and choice in terms of where and when they learn.\u003C\/p\u003E\n\u003Cp id=\u0022p-30\u0022\u003EWe found that the OSCE design was useful in informing the lesson planning and sequencing, and thus attention to the assessment tool can be used in an iterative manner in revising and developing the instructional sequence.\u003C\/p\u003E\n\u003Cp id=\u0022p-31\u0022\u003EA potential confounder in this study is the Hawthorne effect, i.e., the unavoidable fact that the knowledge of the planned OSCE would have acted as a strong motivator for learning. Other confounders to this study include the recall bias inevitable in the textbook and Web-module groups, who could potentially revise up to the day before the OSCE, although we did allow students in the practical group to take notes (reflecting their normal behavior in a practical skills tutorial). Whether an OSCE is an effective way of measuring performance is beyond the scope of this article. We did not prospectively record the time students spent using the module and book or practicing within groups. We are also aware that a knowledge test that has not been formally validated has some limitations as an assessment tool.\u003C\/p\u003E\n\u003Cp id=\u0022p-32\u0022\u003EStudents have different learning styles and perhaps modules such as this will not appeal to all students. Media such as videos seem to \u201cage\u201d quickly; even if the content is sound, changing clothing fashions, for example, can appear to make the content seem out of date. This is less likely with a Web-based module, although it would still need to be maintained in order to relate clearly to the curriculum and to have relevant educational objectives.\u003C\/p\u003E\n\u003Cp id=\u0022p-33\u0022\u003EOur study provides evidence that a well designed Web-based module, supported by sound educational theory, is an effective tool in the teaching of musculoskeletal examination skills. CAL may also provide some advantages over tutor-led teaching in terms of knowledge retention.\u003C\/p\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section app\u0022 id=\u0022app-1\u0022\u003E\n\u003Ch3\u003EAPPENDIX\u003C\/h3\u003E\n\u003Cp id=\u0022p-34\u0022\u003E(For question 2 we accepted any answer that could be found in the module, textbook, or lecture, or was considered reasonable.)\u003C\/p\u003E\n\u003Cp id=\u0022p-35\u0022\u003EKnowledge Test (maximum score 10)\u003C\/p\u003E\n\u003Col class=\u0022list-ord\u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n\u003Cp id=\u0022p-36\u0022\u003EWhat is the correct sequence for examination? ( \/1)\u003C\/p\u003E\n\u003Cp id=\u0022p-37\u0022\u003EInspect \u2013 Palpate \u2013 Active movement \u2013 Passive movement \u2013 Function\u003C\/p\u003E\n\u003Cp id=\u0022p-38\u0022\u003EInspect \u2013 Palpate \u2013 Passive movement \u2013 Active movement \u2013 Function\u003C\/p\u003E\n\u003Cp id=\u0022p-39\u0022\u003EInspect - Function - Active movement \u2013 Passive movement \u2013 Palpate\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n\u003Cp id=\u0022p-40\u0022\u003EName four clinical signs to look for in hand examination ( \/4)\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n\u003Cp id=\u0022p-41\u0022\u003EWhat condition is Phalen\u2019s test used to evaluate ( \/1)\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n\u003Cp id=\u0022p-42\u0022\u003EName two signs to look for at the elbow in a patient with an arthropathy in the hand ( \/2)\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n\u003Cp id=\u0022p-43\u0022\u003EHeberden\u2019s nodes occur in what condition? ( \/1)\u003C\/p\u003E\u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n\u003Cp id=\u0022p-44\u0022\u003EBoggy swelling across the MCP joints of each hand suggests what condition? ( \/1)\u003C\/p\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section fn-group\u0022 id=\u0022fn-group-1\u0022\u003E\u003Ch2\u003EFootnotes\u003C\/h2\u003E\u003Cul\u003E\u003Cli class=\u0022history\u0022 id=\u0022history-1\u0022\u003E\u003Cul class=\u0022history-list\u0022\u003E\u003Cli xmlns:hwp=\u0022http:\/\/schema.highwire.org\/Journal\u0022 class=\u0022accepted\u0022 hwp:start=\u00222008-10-06\u0022\u003EAccepted for publication October 6, 2008.\u003C\/li\u003E\u003C\/ul\u003E\u003C\/li\u003E\u003Cli class=\u0022copyright-statement\u0022 id=\u0022copyright-statement-1\u0022\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022section ref-list\u0022 id=\u0022ref-list-1\u0022\u003E\u003Ch2\u003EREFERENCES\u003C\/h2\u003E\u003Col class=\u0022cit-list ref-use-labels\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E1.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-1-1\u0022 title=\u0022View reference 1. in text\u0022 id=\u0022ref-1\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.1\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EDoherty\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EAbawi\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EPattrick\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EM\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EAudit of medical inpatient-examination: a cry from the joint\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EJ R Coll Physicians Lond\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1990\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E24\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E115\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E8\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DJournal%2Bof%2Bthe%2BRoyal%2BCollege%2Bof%2BPhysicians%26rft.stitle%253DJ%2BR%2BColl%2BPhysicians%2BLond%26rft.issn%253D0035-8819%26rft.aulast%253DDoherty%26rft.auinit1%253DM.%26rft.volume%253D24%26rft.issue%253D2%26rft.spage%253D115%26rft.epage%253D118%26rft.atitle%253DAudit%2Bof%2Bmedical%2Binpatient%2Bexamination%253A%2Ba%2Bcry%2Bfrom%2Bthe%2Bjoint.%26rft_id%253Dinfo%253Apmid%252F2352196%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=2352196\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E2.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-2-1\u0022 title=\u0022View reference 2. in text\u0022 id=\u0022ref-2\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.2\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ECoady\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ED\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EKay\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EL\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EWalker\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ED\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003ERegional musculoskeletal examination: what the students say\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EJ Clin Rheumatol\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2003\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E9\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E67\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E71\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.stitle%253DJ%2BClin%2BRheumatol%26rft.aulast%253DCoady%26rft.auinit1%253DD.%26rft.volume%253D9%26rft.issue%253D2%26rft.spage%253D67%26rft.epage%253D71%26rft.atitle%253DRegional%2Bmusculoskeletal%2Bexamination%253A%2Bwhat%2Bthe%2Bstudents%2Bsay.%26rft_id%253Dinfo%253Apmid%252F17041432%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=17041432\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E3.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-3-1\u0022 title=\u0022View reference 3. in text\u0022 id=\u0022ref-3\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.3\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EVivekananda-Schmidt\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EP\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ELewis\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EHassell\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EAB\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003ECluster randomized controlled trial of the impact of a computer-assisted learning package on the learning of musculoskeletal examination skills by undergraduate medical students\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EArthritis Care Res\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2005\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E53\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E764\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E71\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DArthritis%2BCare%2BRes%26rft.volume%253D53%26rft.spage%253D764%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E4.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-4-1\u0022 title=\u0022View reference 4. in text\u0022 id=\u0022ref-4\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-web\u0022 id=\u0022cit-36.3.623.4\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth cit-collab\u0022\u003EThe Medical Council of Canada\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EObjectives for the qualifying examination\u003C\/span\u003E. \u003Cspan class=\u0022cit-edition\u0022\u003E3rd ed\u003C\/span\u003E. Available from: \u003Ca href=\u0022http:\/\/www.mcc.ca\/objectives_online\/objectives.pl?lang=english\u0026amp;loc=home\u0022\u003Ehttp:\/\/www.mcc.ca\/objectives_online\/objectives.pl?lang=english\u0026amp;loc=home\u003C\/a\u003E [Accessed December 10, 2009].\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E5.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-5-1\u0022 title=\u0022View reference 5. in text\u0022 id=\u0022ref-5\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.5\u0022 data-doi=\u002210.1136\/bmj.322.7277.40\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EGreenhalgh\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ET\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EComputer assisted learning in undergraduate medical education\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EBMJ\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2001\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E322\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E40\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E4\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DGreenhalgh%26rft.auinit1%253DT.%26rft.volume%253D322%26rft.issue%253D7277%26rft.spage%253D40%26rft.epage%253D44%26rft.atitle%253DComputer%2Bassisted%2Blearning%2Bin%2Bundergraduate%2Bmedical%2Beducation%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fbmj.322.7277.40%26rft_id%253Dinfo%253Apmid%252F11141156%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/ijlink\/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjExOiIzMjIvNzI3Ny80MCI7czo0OiJhdG9tIjtzOjIxOiIvanJoZXVtLzM2LzMvNjIzLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-ijlink\u0022\u003E\u003Cspan\u003E\u003Cspan class=\u0022cit-reflinks-full-text\u0022\u003E\u003Cspan class=\u0022free-full-text\u0022\u003EFREE \u003C\/span\u003EFull Text\u003C\/span\u003E\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E6.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-6-1\u0022 title=\u0022View reference 6. in text\u0022 id=\u0022ref-6\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.6\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESmith\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ES\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ERoberts\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EN\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EPartridge\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EM\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EComparison of a web-based package with tutor-based methods of teaching respiratory medicine: subjective and objective evaluations\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EBMC Medical Education\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2007\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E7\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E41\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DBMC%2BMedical%2BEducation%26rft.volume%253D7%26rft.spage%253D41%26rft_id%253Dinfo%253Apmid%252F17976233%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=17976233\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E7.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-7-1\u0022 title=\u0022View reference 7. in text\u0022 id=\u0022ref-7\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.7\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EChaikoolvatana\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EHaddawy\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EP\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EEvaluation of the effectiveness of a computer-based learning (CBL) program in diabetes management\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EJ Med Assoc Thai\u003C\/abbr\u003E\u003Cspan class=\u0022cit-pub-date\u0022\u003E2007\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E90\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E1430\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E34\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DJournal%2Bof%2Bthe%2BMedical%2BAssociation%2Bof%2BThailand%2B%253D%2BChotmaihet%2Bthangphaet%26rft.stitle%253DJ%2BMed%2BAssoc%2BThai%26rft.aulast%253DChaikoolvatana%26rft.auinit1%253DA.%26rft.volume%253D90%26rft.issue%253D7%26rft.spage%253D1430%26rft.epage%253D1434%26rft.atitle%253DEvaluation%2Bof%2Bthe%2Beffectiveness%2Bof%2Ba%2Bcomputer-based%2Blearning%2B%2528CBL%2529%2Bprogram%2Bin%2Bdiabetes%2Bmanagement.%26rft_id%253Dinfo%253Apmid%252F17710988%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=17710988\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E8.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-8-1\u0022 title=\u0022View reference 8. in text\u0022 id=\u0022ref-8\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.8\u0022 data-doi=\u002210.1016\/j.surg.2006.09.012\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EXeroulis\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EG\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EPark\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EMoulton\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EC\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EReznick\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ER\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ELeBlanc\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EV\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EDubrowski\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EA\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003ETeaching suturing and knot-tying skills to medical students: A randomized controlled study comparing computer based video instruction and (concurrent and summary) expert feedback\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ESurgery\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2007\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E141\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E442\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E9\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DSurgery%26rft.stitle%253DSurgery%26rft.aulast%253DXeroulis%26rft.auinit1%253DG.%2BJ.%26rft.volume%253D141%26rft.issue%253D4%26rft.spage%253D442%26rft.epage%253D449%26rft.atitle%253DTeaching%2Bsuturing%2Band%2Bknot-tying%2Bskills%2Bto%2Bmedical%2Bstudents%253A%2Ba%2Brandomized%2Bcontrolled%2Bstudy%2Bcomparing%2Bcomputer-based%2Bvideo%2Binstruction%2Band%2B%2528concurrent%2Band%2Bsummary%2529%2Bexpert%2Bfeedback.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.surg.2006.09.012%26rft_id%253Dinfo%253Apmid%252F17383520%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=10.1016\/j.surg.2006.09.012\u0026amp;link_type=DOI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref\u0022\u003E\u003Cspan\u003ECrossRef\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=17383520\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E9.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-9-1\u0022 title=\u0022View reference 9. in text\u0022 id=\u0022ref-9\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.9\u0022 data-doi=\u002210.1111\/j.1525-1497.2001.10347.x\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EStern\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EDT\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EMangrulkar\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ERS\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EGruppen\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ELD\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ELang\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EAL\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EGrum\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ECM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EJudge\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ERD\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EUsing a multimedia tool to improve cardiac auscultation knowledge and skills\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EJ Gen Intern Med\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2001\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E16\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E763\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E69\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DJournal%2Bof%2Bgeneral%2Binternal%2Bmedicine%2B%253A%2B%2Bofficial%2Bjournal%2Bof%2Bthe%2BSociety%2Bfor%2BResearch%2Band%2BEducation%2Bin%2BPrimary%2BCare%2BInternal%2BMedicine%26rft.stitle%253DJ%2BGen%2BIntern%2BMed%26rft.aulast%253DStern%26rft.auinit1%253DD.%2BT.%26rft.volume%253D16%26rft.issue%253D11%26rft.spage%253D763%26rft.epage%253D769%26rft.atitle%253DUsing%2Ba%2Bmultimedia%2Btool%2Bto%2Bimprove%2Bcardiac%2Bauscultation%2Bknowledge%2Band%2Bskills.%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fj.1525-1497.2001.10347.x%26rft_id%253Dinfo%253Apmid%252F11722691%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=10.1111\/j.1525-1497.2001.10347.x\u0026amp;link_type=DOI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref\u0022\u003E\u003Cspan\u003ECrossRef\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=11722691\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E10.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-10-1\u0022 title=\u0022View reference 10. in text\u0022 id=\u0022ref-10\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.10\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EFarrimond\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EH\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EDornan\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ETL\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ECockcroft\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ERhodes\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ELE\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EDevelopment and evaluation of an e-learning package for teaching skin examination. Action research\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EBr J Dermatol\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2006\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E155\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E592\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E9\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DThe%2BBritish%2Bjournal%2Bof%2Bdermatology%26rft.stitle%253DBr%2BJ%2BDermatol%26rft.aulast%253DFarrimond%26rft.auinit1%253DH.%26rft.volume%253D155%26rft.issue%253D3%26rft.spage%253D592%26rft.epage%253D599%26rft.atitle%253DDevelopment%2Band%2Bevaluation%2Bof%2Ban%2Be-learning%2Bpackage%2Bfor%2Bteaching%2Bskin%2Bexamination.%2BAction%2Bresearch.%26rft_id%253Dinfo%253Apmid%252F16911287%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=16911287\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E11.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-11-1\u0022 title=\u0022View reference 11. in text\u0022 id=\u0022ref-11\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.11\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ERuiz\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJG\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESmith\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ERodriguez\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EO\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003Evan Zuilen\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EMH\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EMintzer\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EMJ\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EAn interactive e-learning tutorial for medical students on how to conduct the performance-oriented mobility assessment\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EGerontol Geriatr Educ\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2007\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E28\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E51\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E9\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DGerontology%2B%2526%2Bgeriatrics%2Beducation%26rft.stitle%253DGerontol%2BGeriatr%2BEduc%26rft.aulast%253DRuiz%26rft.auinit1%253DJ.%2BG.%26rft.volume%253D28%26rft.issue%253D1%26rft.spage%253D51%26rft.epage%253D60%26rft.atitle%253DAn%2Binteractive%2Be-learning%2Btutorial%2Bfor%2Bmedical%2Bstudents%2Bon%2Bhow%2Bto%2Bconduct%2Bthe%2Bperformance-oriented%2Bmobility%2Bassessment.%26rft_id%253Dinfo%253Apmid%252F18032182%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=18032182\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E12.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-12-1\u0022 title=\u0022View reference 12. in text\u0022 id=\u0022ref-12\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.12\u0022 data-doi=\u002210.1093\/rheumatology\/keh138\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ECoady\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ED\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EWalker\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ED\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EJay\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EL\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003ERegional Examination of the Musculoskeletal System (REMS): A core set of clinical skills for medical students\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ERheumatology Oxford\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2004\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E43\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E633\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E9\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DRheumatology%2BOxford%26rft_id%253Dinfo%253Adoi%252F10.1093%252Frheumatology%252Fkeh138%26rft_id%253Dinfo%253Apmid%252F15054154%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/ijlink\/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTI6InJoZXVtYXRvbG9neSI7czo1OiJyZXNpZCI7czo4OiI0My81LzYzMyI7czo0OiJhdG9tIjtzOjIxOiIvanJoZXVtLzM2LzMvNjIzLmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-ijlink\u0022\u003E\u003Cspan\u003E\u003Cspan class=\u0022cit-reflinks-abstract\u0022\u003EAbstract\u003C\/span\u003E\u003Cspan class=\u0022cit-sep cit-reflinks-variant-name-sep\u0022\u003E\/\u003C\/span\u003E\u003Cspan class=\u0022cit-reflinks-full-text\u0022\u003E\u003Cspan class=\u0022free-full-text\u0022\u003EFREE \u003C\/span\u003EFull Text\u003C\/span\u003E\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E13.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-13-1\u0022 title=\u0022View reference 13. in text\u0022 id=\u0022ref-13\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.13\u0022 data-doi=\u002210.1093\/rheumatology\/34.5.421\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ERaj\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EN\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBadcock\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ELJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBrown\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EGA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EDeighton\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ECM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EO\u2019Reilly\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ESC\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EDesign and validation of 2 objective structured clinical examination stations to assess core undergraduate examination skills of the hand and knee\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EJ Rheumatol\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2007\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E34\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E421\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E4\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DThe%2BJournal%2Bof%2BRheumatology%26rft.stitle%253DThe%2BJournal%2Bof%2BRheumatology%26rft.issn%253D0315-162X%26rft.aulast%253DRaj%26rft.auinit1%253DN.%26rft.volume%253D34%26rft.issue%253D2%26rft.spage%253D421%26rft.epage%253D424%26rft.atitle%253DDesign%2Band%2Bvalidation%2Bof%2B2%2Bobjective%2Bstructured%2Bclinical%2Bexamination%2Bstations%2Bto%2Bassess%2Bcore%2Bundergraduate%2Bexamination%2Bskills%2Bof%2Bthe%2Bhand%2Band%2Bknee.%26rft_id%253Dinfo%253Adoi%252F10.1093%252Frheumatology%252F34.5.421%26rft_id%253Dinfo%253Apmid%252F17304661%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/ijlink\/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NjoianJoZXVtIjtzOjU6InJlc2lkIjtzOjg6IjM0LzIvNDIxIjtzOjQ6ImF0b20iO3M6MjE6Ii9qcmhldW0vMzYvMy82MjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-ijlink\u0022\u003E\u003Cspan\u003E\u003Cspan class=\u0022cit-reflinks-abstract\u0022\u003EAbstract\u003C\/span\u003E\u003Cspan class=\u0022cit-sep cit-reflinks-variant-name-sep\u0022\u003E\/\u003C\/span\u003E\u003Cspan class=\u0022cit-reflinks-full-text\u0022\u003E\u003Cspan class=\u0022free-full-text\u0022\u003EFREE \u003C\/span\u003EFull Text\u003C\/span\u003E\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E14.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-14-1\u0022 title=\u0022View reference 14. in text\u0022 id=\u0022ref-14\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.14\u0022 data-doi=\u002210.1136\/ard.51.10.1165\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EDoherty\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EDacre\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EDieppe\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EP\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESnaith\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EM\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EThe GALS locomotor screen\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EAnn Rheum Dis\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1992\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E51\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E1165\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E9\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DAnnals%2Bof%2Bthe%2BRheumatic%2BDiseases%26rft.stitle%253DAnn%2BRheum%2BDis%26rft.issn%253D0003-4967%26rft.aulast%253DDoherty%26rft.auinit1%253DM%26rft.volume%253D51%26rft.issue%253D10%26rft.spage%253D1165%26rft.epage%253D1169%26rft.atitle%253DThe%2B%2527GALS%2527%2Blocomotor%2Bscreen.%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fard.51.10.1165%26rft_id%253Dinfo%253Apmid%252F1444632%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/ijlink\/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTE6ImFubnJoZXVtZGlzIjtzOjU6InJlc2lkIjtzOjEwOiI1MS8xMC8xMTY1IjtzOjQ6ImF0b20iO3M6MjE6Ii9qcmhldW0vMzYvMy82MjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-ijlink\u0022\u003E\u003Cspan\u003E\u003Cspan class=\u0022cit-reflinks-abstract\u0022\u003EAbstract\u003C\/span\u003E\u003Cspan class=\u0022cit-sep cit-reflinks-variant-name-sep\u0022\u003E\/\u003C\/span\u003E\u003Cspan class=\u0022cit-reflinks-full-text\u0022\u003E\u003Cspan class=\u0022free-full-text\u0022\u003EFREE \u003C\/span\u003EFull Text\u003C\/span\u003E\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E15.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-15-1\u0022 title=\u0022View reference 15. in text\u0022 id=\u0022ref-15\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-book\u0022 id=\u0022cit-36.3.623.15\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBickley\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ELS\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESzilagyi\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EPG\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EBates\u2019 guide to physical examination and history taking\u003C\/span\u003E. \u003Cspan class=\u0022cit-edition\u0022\u003E9th ed\u003C\/span\u003E. \u003Cspan class=\u0022cit-publ-loc\u0022\u003EPhiladelphia\u003C\/span\u003E: \u003Cspan class=\u0022cit-publ-name\u0022\u003ELippincott Williams \u0026amp; Wilkins\u003C\/span\u003E; \u003Cspan class=\u0022cit-pub-date\u0022\u003E2007\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E497\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E573\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E16.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-16-1\u0022 title=\u0022View reference 16. in text\u0022 id=\u0022ref-16\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.16\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ERaj\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EN\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBadcock\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ELJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBrown\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EGA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EDeighton\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ECM\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EO\u2019Reilly\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003ESC\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EUndergraduate musculoskeletal examination teaching by trained patient educators: A comparison with doctor led teaching\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EJ Rheumatol\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2006\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E45\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E1404\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E8\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DJ%2BRheumatol%26rft.issn%253D0315-162X%26rft.volume%253D45%26rft.spage%253D1404%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E17.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-17-1\u0022 title=\u0022View reference 17. in text\u0022 id=\u0022ref-17\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.17\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ELyon\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EHC\u003C\/span\u003E, \u003Cspan class=\u0022cit-name-suffix\u0022\u003EJr\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EHealy\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJC\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EBell\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJR\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EPlanAlyzer, an interactive computer-assisted program to teach clinical problem solving in diagnosing anemia and coronary artery disease\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EAcad Med\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E1992\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E67\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E821\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E8\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DAcademic%2BMedicine%26rft.stitle%253DAcad.%2BMed.%26rft.issn%253D1040-2446%26rft.aulast%253DLyon%26rft.auinit1%253DH.%26rft.volume%253D67%26rft.issue%253D12%26rft.spage%253D821%26rft.epage%253D828%26rft.atitle%253DPlanAlyzer%252C%2Ban%2Binteractive%2Bcomputer-assisted%2Bprogram%2Bto%2Bteach%2Bclinical%2Bproblem%2Bsolving%2Bin%2Bdiagnosing%2Banemia%2Band%2Bcoronary%2Bartery%2Bdisease%26rft_id%253Dinfo%253Apmid%252F1457015%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=1457015\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E18.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-18-1\u0022 title=\u0022View reference 18. in text\u0022 id=\u0022ref-18\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.18\u0022 data-doi=\u002210.1093\/rheumatology\/kel077\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EWilson\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EGoodall\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EAmbrosini\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EG\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-etal\u0022\u003Eet al\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EDevelopment of an interactive learning tool for teaching rheumatology \u2014 a simulated clinical case studies program\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003ERheumatology Oxford\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2006\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E45\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E1158\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E61\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DRheumatology%2BOxford%26rft_id%253Dinfo%253Adoi%252F10.1093%252Frheumatology%252Fkel077%26rft_id%253Dinfo%253Apmid%252F16531436%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/ijlink\/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTI6InJoZXVtYXRvbG9neSI7czo1OiJyZXNpZCI7czo5OiI0NS85LzExNTgiO3M6NDoiYXRvbSI7czoyMToiL2pyaGV1bS8zNi8zLzYyMy5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-ijlink\u0022\u003E\u003Cspan\u003E\u003Cspan class=\u0022cit-reflinks-abstract\u0022\u003EAbstract\u003C\/span\u003E\u003Cspan class=\u0022cit-sep cit-reflinks-variant-name-sep\u0022\u003E\/\u003C\/span\u003E\u003Cspan class=\u0022cit-reflinks-full-text\u0022\u003E\u003Cspan class=\u0022free-full-text\u0022\u003EFREE \u003C\/span\u003EFull Text\u003C\/span\u003E\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E19.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-19-1\u0022 title=\u0022View reference 19. in text\u0022 id=\u0022ref-19\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.19\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EPaas\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EF\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ERenkle\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003ESweller\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJ\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003ECognitive load theory and instructional design: Recent developments\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EEduc Psychol\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2003\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E38\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E1\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E4\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DEduc%2BPsychol%26rft.volume%253D38%26rft.spage%253D1%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E20.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-20-1\u0022 title=\u0022View reference 20. in text\u0022 id=\u0022ref-20\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.20\u0022 data-doi=\u002210.1046\/j.1365-2923.2002.01260.x\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EOwen\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EH\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EPlummer\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJL\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003EImproving learning of a clinical skill: The first year\u2019s experience of teaching endotracheal intubation in a clinical simulation facility\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EMed Educ\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2002\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E36\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E635\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E42\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DMedical%2Beducation%26rft.stitle%253DMed%2BEduc%26rft.aulast%253DOwen%26rft.auinit1%253DH.%26rft.volume%253D36%26rft.issue%253D7%26rft.spage%253D635%26rft.epage%253D642%26rft.atitle%253DImproving%2Blearning%2Bof%2Ba%2Bclinical%2Bskill%253A%2Bthe%2Bfirst%2Byear%2527s%2Bexperience%2Bof%2Bteaching%2Bendotracheal%2Bintubation%2Bin%2Ba%2Bclinical%2Bsimulation%2Bfacility.%26rft_id%253Dinfo%253Adoi%252F10.1046%252Fj.1365-2923.2002.01260.x%26rft_id%253Dinfo%253Apmid%252F12109985%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=10.1046\/j.1365-2923.2002.01260.x\u0026amp;link_type=DOI\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref\u0022\u003E\u003Cspan\u003ECrossRef\u003C\/span\u003E\u003C\/a\u003E\u003Ca href=\u0022\/lookup\/external-ref?access_num=12109985\u0026amp;link_type=MED\u0026amp;atom=%2Fjrheum%2F36%2F3%2F623.atom\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-medline\u0022\u003E\u003Cspan\u003EPubMed\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022ref-label\u0022\u003E21.\u003C\/span\u003E\u003Ca class=\u0022rev-xref-ref\u0022 href=\u0022#xref-ref-21-1\u0022 title=\u0022View reference 21. in text\u0022 id=\u0022ref-21\u0022\u003E\u21b5\u003C\/a\u003E\u003Cdiv class=\u0022cit ref-cit ref-journal\u0022 id=\u0022cit-36.3.623.21\u0022\u003E\u003Cdiv class=\u0022cit-metadata\u0022\u003E\u003Col class=\u0022cit-auth-list\u0022\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003Evan Merrienboer\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EJJG\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EKirschner\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EPA\u003C\/span\u003E\u003C\/span\u003E, \u003C\/li\u003E\u003Cli\u003E\u003Cspan class=\u0022cit-auth\u0022\u003E\u003Cspan class=\u0022cit-name-surname\u0022\u003EKester\u003C\/span\u003E \u003Cspan class=\u0022cit-name-given-names\u0022\u003EL\u003C\/span\u003E\u003C\/span\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003Ccite\u003E. \u003Cspan class=\u0022cit-article-title\u0022\u003ETaking the load off a learner\u2019s mind: Instructional design for complex learning\u003C\/span\u003E. \u003Cabbr class=\u0022cit-jnl-abbrev\u0022\u003EEduc Psychol\u003C\/abbr\u003E \u003Cspan class=\u0022cit-pub-date\u0022\u003E2003\u003C\/span\u003E;\u003Cspan class=\u0022cit-vol\u0022\u003E38\u003C\/span\u003E:\u003Cspan class=\u0022cit-fpage\u0022\u003E5\u003C\/span\u003E\u2013\u003Cspan class=\u0022cit-lpage\u0022\u003E13\u003C\/span\u003E.\u003C\/cite\u003E\u003C\/div\u003E\u003Cdiv class=\u0022cit-extra\u0022\u003E\u003Ca href=\u0022{openurl}?query=rft.jtitle%253DEduc%2BPsychol%26rft.volume%253D38%26rft.spage%253D5%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx\u0022 class=\u0022cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url\u0022\u003E\u003Cspan\u003EOpenUrl\u003C\/span\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/li\u003E\u003C\/ol\u003E\u003C\/div\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/www.jrheum.org\/content\/36\/3\/623.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Abstract\u003C\/a\u003E\u003C\/div\u003E \u003C\/div\u003E\n\n \n \u003C\/div\u003E\n\u003Cdiv class=\u0022panel-separator\u0022\u003E\u003C\/div\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-article-trendmd\u0022 \u003E\n \n \n \n \u003Cdiv class=\u0022pane-content\u0022\u003E\n \u003Cdiv id=\u0022trendmd-suggestions\u0022\u003E\u003C\/div\u003E \u003C\/div\u003E\n\n \n \u003C\/div\u003E\n\u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/www.jrheum.org\/sites\/default\/files\/js\/js_K2T1hD7TX-0Jbkpzu0UMR6PH_mcgmcEjtp96DIZJ-_s.js\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}